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Executive summary

Health of the elderly

The increase in the number of old people in the world will be one of the most profound forces affecting health and social services in the next century. Overall, the world's population has been growing at an annual rate of 1.7% during the period 1990-1995 - but the population aged over 65 is increasing by some 2.7% annually. Of a world total of 355 million people over 65 in 1993, more than 200 million are in the developing world, where they make up 4.6% of the population, with more than 150 million in developed countries, where the proportion is 12.6%. Although Europe, Japan and the USA currently have the "oldest" populations, the most rapid changes are being seen in the developing world, with predicted increases in some countries of up to 400% in people aged over 65 during the next 30 years.

Alongside the increase in the number of people over age 65, there will also be a dramatic rise in the numbers of "old old" - people over 80. In 1993 they constituted 22% of those over 65 in developed countries and 12% in the developing world. The world elderly support ratio (the number of people over 65 years compared to those aged 20-64) in 1990 was 12 elderly to every 100 people of working age. It is estimated that the figure will be 12.8 in the year 2000 and 13.2 in 2010. In other words, while population increase during 1990-2000 is estimated to be 17%, the increase in the number of elderly is likely to be 30%.

One of the most difficult questions for health planners and politicians trying to allocate funds, as well as for the community and individuals themselves, is whether increased life expectancy means more health or simply more years of sickness. This is an area that is greatly underresearched, yet the question is assuming ever greater importance.

Two of the most pressing problems in the future will be the provision of care for people with dementia and those needing joint replacements for arthritic diseases. WHO estimates that there are 165 million people in the world with rheumatoid arthritis. The long-term care of the frail elderly is becoming one of the most debated medical and political issues in many developed countries, and the developing world too will soon have to wrestle with it. If people are not to be left destitute and uncared for at the end of their lives, more attention must be given to social mechanisms for the support of the elderly and the means to fund them.